Steroid Cream for Psoriasis

Steroid creams for psoriasis are topical corticosteroids. Available by prescription, these medications help to relieve the itching and discomfort of a psoriasis rash.

Topical corticosteroids come as creams, foams, gels, ointments, or solutions in a variety of strengths. Prescriptions commonly include clobetasol, triamcinolone, and hydrocortisone.

Unlike oral steroids that disseminate the active drug through the body, these medications penetrate the skin and go directly to the affected cells.

Topical corticosteroids can help treat psoriasis by:

• Reducing inflammation
• Slowing the hyperproduction of skin cells
• Reducing the appearance of psoriatic skin lesions
• Alleviating itching and discomfort
• Aiding the shedding of scaly skin

This article discusses steroid psoriasis creams. It explains the different topical corticosteroids used to clear psoriasis and the potential side effects of these medications.

How Corticosteroids Help Psoriasis

Psoriasis is an inflammatory autoimmune disease in which the immune system suddenly regards normal skin cells as harmful. In response to the perceived threat, the immune system will launch an inflammatory attack on the middle and upper layers of skin (known, respectively, as the dermis and epidermis).

The inflammation, in turn, will accelerate the production of skin cells, causing them to build up and form dry, scaly lesions known as plaques.

By taking corticosteroid drugs, either topically or by mouth, abnormal autoimmune inflammation can be reduced and, with it, the symptoms of psoriasis.

With consistent use, steroid creams are often enough to clear up a psoriasis flare. However, some people with psoriasis benefit from more aggressive treatments. These include UV light therapy, retinoids, and disease-modifying antirheumatic drugs (DMARDs).

Topical Steroid Formulations

Not all topical corticosteroids are the same. Your healthcare provider will prescribe the option best suited for you based on, among other things, the location of your plaques and the general state of your skin. There are several different formulations they can choose from:

• Ointments are made from petrolatum (petroleum jelly) and tend to be greasy.
• Creams are medium-weight and well-suited for delicate skin.
• Lotions are lightweight due to being water-based. They're a bit weaker than creams and ointments.
• Oils can be used for whole-body treatment or as an overnight scalp treatment.
• Gels are non-greasy and easily absorbed into the skin, making them great for the scalp and other hairy areas. 
• Foams can also be easily massaged into the scalp.
• Tapes are infused with corticosteroid drugs. They are appropriate for thicker plaques on the elbows or knees. 

Your healthcare provider will choose the option that delivers the appropriate amount of drug based not only on the drug concentration but the absorptive capacity of the skin.

Ointments, for example, are typically stronger than creams and may be better for thicker plaques. Lotions or creams, by contrast, may be appropriate for the delicate skin of the face, armpits, or groin.

How to Apply Corticosteroids

Topical corticosteroids should be used as prescribed. Psoriasis creams are typically applied to the affected areas one to four times a day. Follow these directions to safely apply topical corticosteroids to psoriasis plaques, lesions, and rashes:

1. Before applying a topical steroid, wash your hands.
2. Using a small amount, apply a thin layer of medication and massage it into the affected area.
3. Do not apply corticosteroids to other areas of your skin unless directed by your healthcare provider.
4. Avoid getting topical corticosteroids in your eyes, mouth, or mucous membranes.
5. Replace the cap and wipe off any medication from the outside of the container.
6. When you are finished, wash your hands again to make sure you don't have any medication on your fingertips.

Never apply a topical corticosteroid to skin other than that directed by your dermatologist. This is especially true with respect to the genitals and face.

Topical steroid treatment is typically used until the psoriatic rash clears up. For more severe outbreaks, your dermatologist may start you with a stronger topical medication. This can better penetrate thickened psoriasis plaques. Once the major scaling has been reduced, you may be switched to a milder steroid cream.

Some corticosteroids are used on an intermittent basis whenever signs of a psoriasis flare begin to develop. These will usually be milder (Class VI or VII) drugs that can be applied when needed.

Always check the expiration date and let your healthcare provider know well in advance if you need a refill. Steroid creams and ointment tubes can get messy. It can be helpful to store them in their original box with the prescription label.

Classes of Topical Steroids

Topical steroids come in seven different classes. The mildest topical steroids, categorized as Class VII, include over-the-counter 1% hydrocortisone cream. The strongest topical steroids, known as Class I, include more aggressive preparations like clobetasol.

Keep in mind that the greater the potency of a topical corticosteroid, the greater the risk of side effects. It's important that your psoriasis be treated based on its severity.

Topical Steroid Class I

These topical steroids have the highest potency overall:

• Diprolene (betamethasone dipropionate 0.05% ointment or gel)
• Temovate (clobetasol propionate 0.05% cream, ointment, or shampoo)
• Ultravate (halobetasol propionate 0.05% cream, ointment, or lotion)
• Vanos (fluocinonide 0.1% cream)

Topical Steroid Class II

These topical steroids are considered highly potent:

• Cyclocort (amcinonide 0.1% ointment)
• Halog (halcinonide 0.1% cream, ointment, or solution)
• Lidex (fluocinonide 0.05% cream, gel, ointment, or solution)
• Topicort (desoximetasone 0.25% cream or ointment)

Topical Steroid Class III

These topical steroids are considered potent:

• Cutivate (fluticasone propionate 0.005% ointment)
• Elocon (mometasone furoate 0.1% ointment)
• Florone (diflorasone diacetate 0.05% cream)
• Topicort LP (desoximetasone 0.05% cream)

Topical Steroid Class IV

These topical steroids are considered medium potent:

• Cordran (flurandrenolide 0.05% cream, ointment, or lotion)
• Cutivate (fluticasone propionate 0.05% cream)
• Kenalog (triamcinolone acetonide 0.025% cream or 0.1% lotion)
• Synalar (fluocinolone acetonide 0.025% cream or ointment)
• Triderm (triamcinolone acetonide 0.1% cream, ointment, or lotion)

Topical Steroid Class V

These topical steroids are considered lower-mid potent:

• Westcort (hydrocortisone valerate 0.2% cream or ointment)
• Locoid (hydrocortisone butyrate 0.1% ointment)
• Dermatop (prednicarbate 0.1% cream or ointment)
• Pandel (hydrocortisone probutate 0.1% cream)

Topical Steroid Class VI

These topical steroids are considered mild:

• DesOwen (desonide 0.05% lotion, gel, cream, or ointment)
• Kenalog (triamcinolone acetonide 0.025% cream or lotion)
• Synalar (fluocinolone acetonide 0.01% cream, solution, or shampoo)

Topical Steroid Class VII

These topical steroids are the least potent overall:

• Hytone (hydrocortisone 2.5% cream or lotion)
• Hydrocortisone 1% cream, ointment, or lotion
• Hydrocortisone 2% and 2.5% cream, ointment, or lotion
• Hydrocortisone acetate 2% and 2.5% cream or ointment

Side Effects of Topical Steroids

Class I steroids are not just a little stronger than Class VII; they are between 600 and 1,000 times stronger. These ultra-high-potency preparations have the greatest efficacy overall but also the most side effects. As a result, a Class VII topical steroid may only be prescribed for two to three weeks, while a Class I drug may be used for longer periods.

The likelihood of side effects increases with the drug's strength and the duration of treatment. Use the medication as prescribed and avoid using more than directed.

Possible sides effects of topical corticosteroids include:

• Stinging or burning sensations
• Skin redness (erythema)
• Acne
• Rosacea
• Skin thinning (atrophy)
• Stretch marks (striae) in the armpits or groin
• Easy bruising and tearing of the skin
• Enlarged blood vessels (telangiectasia)
• Increased localized hairiness (hypertrichosis)
• Hypopigmentation of the treated skin

Many of the more severe symptoms can occur after weeks or months of treatment. It is important to stop treatment and call your healthcare provider should any skin abnormality develop. Any damage to the skin may be permanent.

Can Steroid Cream Make Psoriasis Worse?

On their own, topical corticosteroids should not cause psoriasis symptoms to worsen. However, combination treatments can. For example, a worsening of psoriasis is a less common side effect of Enstilar, which combines the corticosteroid betamethasone with calcipotriene, a form of vitamin D.

A worsening of psoriasis when using topical steroids could also indicate an allergy to an active or inactive ingredient. If you experience a worsening of psoriasis symptoms after applying steroid cream, discontinue use and contact your prescriber.

When and How to Taper off Steroids

If a topical corticosteroid is used for an extended period, you may need to slowly taper off the medication. If stopped abruptly, topical steroids can cause withdrawal.

Symptoms of corticosteroid withdrawal include:

• A severe rebound of psoriasis symptoms
• Extreme sensitivity to heat or cold
• Resistance to topical medications
  

To prevent steroid withdrawal, your healthcare provider will taper the dose gradually over weeks or months. If you experience a worsening of symptoms during the tapering phase, call your practitioner.